I teach how to share news in medical school. My own unexpected pregnancy made it personal

Some years ago I taught a class in medical school on “Breaking Bad News”. I never liked the title, but I inherited it and was not allowed to change it. So I used it to deconstruct what we meant by “breaking” and “bad”. We know that assumptions by a clinician on whether it is “good” or “bad” news impacts how it’s delivered to a patient. In turn, that delivery, along with the news itself and the patient’s own view on its value, influence a patient’s response.

To encourage students to consider the complexity around giving news a value, I used invented examples. These were: a) telling someone they had a particular diagnosis, which on the face of it appears to be bad news, but gives a name and the attendant social validity to a patient’s symptoms; and b) telling someone they were pregnant, which might seem like good news when that might not be the case.

It turns out the latter was prescient to my own experience. It was always in the “there is no way that could ever happen to me” category. After having three wonderful children we had decided we were done. We had been extraordinarily lucky with getting pregnant with relative ease and no miscarriages. I often joked that being pregnant was the only thing my body was really good at.

I am a research and teaching academic in clinical communication. Two weeks into the teaching session, at 37 years old, I found myself pregnant, despite using contraception.

Patients often, though not always, have some idea when something serious is going on. News, then, is not often “broken”. I knew I was pregnant when I took the two at-home tests on a Wednesday night. I did not have more information about how far along or whether it was viable, but the first bit of news delivery came from me to my GP during a telehealth appointment. My voice shaky and with some tears, I told her I was scared. But she reassured me so kindly. This was not my fault, contraception is not foolproof.

The two blood tests were vastly different from each other, with a joyful question about whether I was pregnant at the first and then almost no conversation at the second.

Because of the timing of the results, my GP delivered the news across two different phone calls. The first was that I was six to seven weeks pregnant. This was a surprise, as I had thought it would be less. The second was that the pregnancy was likely unviable as the hormone that usually doubles every two days during the first weeks of pregnancy had not even come close. My GP was calm and clear and responded to me with empathy.

I managed to get a cancellation appointment for a scan as I had not started to visibly miscarry. After finishing work early I arrived at the imaging place. The sonographer called my husband and me into the room. I pre-empted the sonographer’s evaluation of the news, using my own forecasting strategy, by saying that I had blood tests that indicated that the pregnancy was miscarrying and that I had some pain on one side, so I suspected that it might be ectopic. The conversation was very different from scans for my previous pregnancies. The sonographer asked how much information we wanted, asked if we wanted the patient viewing screen off, and checked in as she went along.

The sonographer prepared us – there was nothing in the uterus but there was something near the right ovary. She would need to get the doctor to have a look. It was clear to the doctor that it was a large tubal pregnancy that would need to be surgically removed. There was no decision to be made, it needed intervention. Then we saw my regular obstetrician, who told us it was actually quite large, and so it was surprising that it had not ruptured. It needed to be operated on as soon as possible.

What struck me was the collaborative and cumulative construction of the news across the week and particularly when it was found to be ectopic. The news was not broken, like a wave crashing on to us. It was a tide rising around us. It almost consumed me, and it might have, had it been broken. I would have been lost under its waves. But I could see it rising. I knew what was coming and I could keep my head above water.

There is no doubt that these clinicians had considered the complexity of news delivery. They considered what I already knew, what I might be expecting to hear, and how I might react. They avoided evaluations of the news and instead were responsive to my emotions and my words. They considered my context at that moment within news delivery, allowing me to share my perspective, and, in doing so, engaged me in the news delivery process.

Going through this experience has taught me that while “Breaking Bad News” might sound good, ultimately it detracts from the complexity of sharing news with patients. By reducing it to a catchy title, we are doing a disservice to those we train in news delivery as well as to their patients going forward.

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